Silicosis- CT Findings

This is a 59 year old male with history, working in mine company.  Possible silicosis with small nodular shadowing and relative sparing of the lung bases.


CT findings in Silicosis:

Small well-defined nodules of 2 to 5mm in diameter in both lungs.
Upper lobe predominance
Nodules may be calcified
Centrilobular and subpleural distribution
Sometimes random distribution
Irregular conglomerate masses, known as progressive massive fibrosis
Often hilar and mediastinal lymphnodes.

Interstitial Lung Disease Series-Part 3- Cryptogenic organizing pneumonia

ILD is one of the most difficult topics for the residents to understand. We have put together simple series with points to remember for each type. We agree, it is highly controversial and our points are comprehensive and may need revision periodically.  All we are offering are some typical things to remember and pictures and this in no way is exhaustive and conclusive. This is the third  case in the series.

Main Contributor- Dr MGK Murthy.

Edited and Series Concept by Sumer Sethi

Case Number-3

There are 6 types of Idiopathic Interstitial Pneumonias, also called interstitial lung disease. We will present six posts in this series called as Interstitial Lung Disease Series.

Cryptogenic organizing pneumonia 

Cryptogenic organizing pneumonia  shows  airspace consolidation overlying some other disease at times like SLE with loss of volume.

Short Note on Cryptogenic organizing pneumonia 

Male=female (40 to 50y)

Relatively short like Flu
Granulation tissue obliterating alveolar ducts/spaces

CXR- Bilateral diffuse peripheral alveolar opacities

HRCT- patchy airspace ground glass(90%), some nodules, Bronchial wall thickening & patchy peripheral prepoderance

Treatment- steroids

Mortality Rare but recurrence is high

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Interstitial Lung Disease Series-Part 2- Non specific Interstitial Pneumonia

ILD is one of the most difficult topics for the residents to understand. We have put together simple series with points to remember for each type. We agree, it is highly controversial and our points are comprehensive and may need revision periodically.  All we are offering are some typical things to remeber and pictures and this in no way is exhaustive and conclusive. This is the second case in the series.
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Main Contributor- Dr MGK Murthy.
Edited and Series Concept by Sumer Sethi

There are 6 types of Idiopathic Interstitial Pneumonias, also called interstitial lung disease. We will present six posts in this series called as Interstitial Lung Disease Series.

Case Number-2

Non specific Interstitial Pneumonia- second commonest amongst pulmonary fibrosis, just after Usual Interstitial Pneumonia

Note:  symmetric lower lobe involvement(typical), Relative subpleural sparing,  groundglass opacities, peribronchovascular fibrosis, mild reticular abnormalities, and traction bronchiectasis prominent

Golden Point 
Ground-glass abnormality is a common finding in many diffuse lung diseases, including all of the IIPs except UIP . Therefore, although its presence cannot help one make the diagnosis of NSIP, the absence of ground-glass abnormality can steer one toward a diagnosis of UIP, even if no honeycombing is present.

Short Note on Non specific Interstitial Pneumonia

Non smoking Women(40 to50yr)
Relatively  short  history
CXR- BLZ reticular and patchy opacities  rarely unilateral   D/D eosinophilic pneumonia    
HRCT- Bilateral patchy groundglass, irregular lines, bronchial dilatation                                                                                                                                            
Treatment- Steroids                                                      
Mortality- <10% in 5 yrs  

Interstitial Lung Disease Series-Part 1- Usual Interstitial pneumonia

ILD is one of the most difficult topics for the residents to understand. We have put together simple series with points to remember for each type. We agree, it is highly controversial and our points are comprehensive and may need revision periodically.  All we are offering are some typical things to remeber and pictures and this in no way is exhaustive and conclusive .

Main Contributor- Dr MGK Murthy.
Edited and Series Concept by Sumer Sethi

There are 6 types of Idiopathic Interstitial Pneumonias, also called interstitial lung disease. We will present six posts in this series called as Interstitial Lung Disease Series.

Case Number-1

Usual Interstitial pneumonia
Points to be noted

-lower lobes symmetrical  involvement
-extensive honey combing
-absence of ground glass opacities
-lack of subpleural sparing

Short Notes on Usual Interstitial pneumonia 

Mostly male smokers      
Takes years to develop
Exertional dyspnoea and cough
HPE       Alveolar epithelialcell injury              
CXR       Diffuse Reticular shadows both lower zones  & peripheral cystic honeycombing  
HRCT     Traction Bronchiectasis, diffuse patchy subpleural  reticulations  
Treatment     Lung transplant  
Morality    50-70%in 5 yrs      

Pulmonary Fibrosis- CXR

76 yr old compalints of shortness of breath with history of COPD with decreased oxygen saturation with no definite occupational history relating to toxins/pollutants. There is extensive, ill defined reticular hard shadowing  in all zones  with suggestion of Rt CP angle blunting and rt diaphragmatic, possible calcium with no significant Rt ventricular enlargement  on this film.

Best  described as Dirty lung fields.

Teaching points

-Hard reticular shadows with some subpleural nodules  with at places loss of  tissue interfaces

-Rt pleural thickening along with plaque diaphragmatic region

-Questionable mediastinal adenopathy

-Few areas of focal hyper inflation

-Heart not conformity to  COPD with pulmonary conus not full

Xray diagnosis could suggest Pulmonary fibrosis - needs compariosn with old Xrays/ HRCT evaluation

Pulmonary fibrosis

Definition: literally scarring andreplacemnt of lung tisue with fibrous tisue

Classification: at the most confusing and rapidly changing as the etiology and types are broad progresses rapidly after 40s and 50 s, presents with shortness of breath and dry cough, typically misdiagnosed initially in view of clinical mimic to infection/embolism/COPD/ heart failure /Asthma etc. Xray chest could be normal adding to the misdiagnosis

Restrictive lung disease suggested by maintained FEV1/Fvital capacity  , though the latter is decreased  depending on the etiology radiolgical features vary idiopathic may show usual interstitial patern(UIP)  

More on this will be presented with HRCT picture -look out for it.